If you’re tired during the day, you may suffer from Sleep Apnea, a condition that interrupts normal sleep many times a night. Yet this health danger remains hidden to many of us—we may have no recollection of the multiple arousals that have disrupted our sleep, and a spouse is often the one who may notice that something is amiss. Numerous studies indicate dangerous links between Sleep Apnea and a host of other health problems, including Heart Disease, High Blood Pressure, Diabetes, Depression, and much more.
What is Sleep Apnea?
Many people snore when the airway becomes partially obstructed by tongue or esophageal tissues during sleep, causing vibrations. If the obstruction worsens, obstructive sleep apnea (OSA) can occur, resulting in episodes of nearly or totally stopped breathing, from which we are then momentarily roused from sleep.
The most common obstructive sleep apnea occurs in 10% of men and 45% of women, and progresses with age to a staggering 70% of men and 50% of women over 65. Can you imagine waking up 20-50 times per hour? It’s no wonder OSA patients suffer from chronic fatigue and daytime sleepiness.
Health Risks
Sleep deprivation can cause irritability, confusion, illness, poor performance at work and drowsy driving…not to mention the effects it can have on a spouse and the potential subsequent strain on one’s marriage or relationship.
But there are many other medical health risks associated with sleep apnea. Repeated deprivation of oxygen to the brain can cause high blood pressure which can damage the carotid arteries on each side of the neck. This can restrict blood flow to the brain and lead to stroke. A report from the University of California School of Dentistry found that 21% of men who snore had hardened blockages in their carotid arteries. Another study published in 2008 stated that loud snorers had 40% greater odds of having hypertension, 34% greater odds of having a heart attack and 67% greater odds of having a stroke than people who did not snore.
Health Risks of Untreated Sleep Apnea:
- Angina (chest pain)
- Gastro Esophageal Reflux (Acid Reflux)
- Cardiac changes
- Increased Atherosclerosis (hardening of the arteries)
- Increased blood pressure
- Poor memory; Attention disorders in children
- Depression, anxiety, personality problems, stress
- Two times more likely to clench and grind teeth
- Obesity
- Frequent nighttime waking to use the bathroom
- Hypoxemia (low blood oxygen levels)
- Hypercapnia (high carbon dioxide levels)
- Increased or decreased heart rate (Arrhythmias)
- Right congestive heart failure (Sudden Death)
- Hypothyroidism (low thyroid function)
- Polycythemia (abnormal increased blood cell numbers)
- Increased hydrogen dioxide (unbalanced blood ph)
- Sleepiness, marital, work problems, auto accidents
- Respiratory failure
- Diabetes
- Morning headaches
- Fibromyalgia
- Growth hormone related problems
Risk Factors
Factors that have been associated with greater risk of snoring or obstructive sleep apnea include:
- Male
- Overweight
- Neck Size ≥17” in men; ≥15” in women
- Oversized tongue
- Narrow arch, narrow palate
- Retruded lower jaw profile
- Enlarged tonsils or adenoids (especially children)
- Family history
- Sedative medicines, alcohol
Diagnosis & Self-Tests
On a daily basis, our dental office looks for clues that may identify potential patients with sleep disorders. Examples include:
- Bruxism; worn, chipped teeth
- Morning headaches; sore jaw muscles
- TMJ problems
- Bite feels off
- History of acid erosion; GERD, acid taste in the morning, eroded teeth
- Snoring reported
- Apnea diagnosis, but not using C-PAP
- Tired during the day
- Mouth breathing, enlarged uvula, nasal obstruction
- Large tongue, scalloped tongue
- Retruded lower jaw/teeth
- Small, narrow mouth
- Overweight, large neck
- Family history
- High blood pressure
- Diabetes
- Heart Condition
If suspected, the next step is a screening/questionnaire often completed with help from your bed partner. Depending on the results, we can help you with further recommendations, including referral to a sleep specialist; an Ear, Nose and Throat specialist; and/or a gastroenterologist.
Major Study: Depression and Sleep Apnea
A recent large-scale study conducted by the Centers for Disease Control (CDC) concluded that obstructive sleep apnea and other symptoms of OSA are associated with depression, regardless of additional factors like weight, age, sex or race. Researchers found that men with diagnosed sleep apnea are more than twice as likely as other men to show signs of clinical depression, such as feelings of hopelessness and disinterestedness in everyday activities. For women, the results were even more striking: A sleep apnea diagnosis made the likelihood of depression symptoms five times more likely.
Treatment Options For Sleep Apnea
Mild to Moderate Sleep Apnea
For patients with mild to moderate obstructive sleep apnea, dental appliances or oral mandibular advancement devices that prevent the tongue from blocking the throat and/or advance the lower jaw forward can be made. These devices help keep the airway open during sleep.
Dental appliances are the #1 non-surgical treatment solution recommended by the American Academy of Sleep Medicine for patients diagnosed with mild to moderate sleep apnea. Oral appliances are often very effective, with a 52% – 80% success rate, while also reducing bruxism (teeth-grinding) effects.
Specific dental appliances can address impaired mouth syndrome—where the tongue (a 6-foot tiger) is squished into a mouth that is too small (a 3-foot cage). With these appliances, small increases in the size of the jaws can be accomplished to make more room for the tongue in the mouth, free the mandible from entrapment by the maxilla, and improve whole body symptoms related to impaired mouth syndrome.
A sleep specialist and dentist with expertise in oral appliances for this purpose should jointly determine if this treatment is best for you.
Severe Sleep Apnea
A C-PAP or bi-PAP is highly recommended for cases of severe sleep apnea. These are machines that deliver a constant flow of mild air pressure to keep the airway open. Other treatments may include surgery of the nose, palate, and throat, as well as medications. Treatment would be based on an evaluation by an Ear, Nose and Throat specialist or sleep medicine specialist.
Beware of “cheap” internet solutions
A word to the wise about over the counter and Internet remedies. Although attractive because of low cost, they have three inherent caveats:
- They may mask high risk, undiagnosed sleep apnea and associated risks
- They may cause tooth movement
- They may cause jaw joint problems
Questions or concerns? Please call our office today and talk to any of our friendly and knowledgeable team members!